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Outdoors enthusiasts urged to practice tick bite prevention

Experts say using commercially available repellents, like permethrin for clothing and DEET for skin, is the most effective way to keep disease-carrying ticks from biting. Tests show both are safe at commercially available doses. Bob King / Forum News Service1 / 2

Formerly called deer ticks, blacklegged ticks like this one crawling on skin, can carry multiple diseases, including Lyme. As ticks get more active in May experts are urging people outdoors to use repellents to keep them away. Contributed photo / U.S. Department of Agriculture2 / 2

GRAND RAPIDS, MInn. — Rick Horton of Grand Rapids was just back from a spring turkey when he noticed the ticks, about a dozen of them, dug into his skin.

"They were several on my back, between my shoulder blades. And several in places I can't mention," said Horton, who spent three days crawling around in Kansas prairie grass to shoot a tom turkey. "I was camping out. No shower. I was literally crawling on top of ticks for three days. And I didn't do anything to prevent it."

Horton and his wife eventually pulled them all out. But soon after, Horton's lymph nodes started to rapidly swell. He went to his doctor, who immediately prescribed a dose of the antibiotic doxycycline.

"It cleared it right up,'' Horton said. "I got lucky. I've never had Lyme disease and most every other wildlife biologist I know has had it once. Some have had it multiple times."

Horton, a biologist with the National Wild Turkey Federation, now takes tick precautions very seriously.

"Now, I soak my hunting pants with permethrin. And I have a (turkey hunting face mask) that's designed to keep them off,'' he said. "I'm not taking chances anymore."

With Lyme disease on the increase in Minnesota for more than 20 years, it would seem everyone who spends time outdoors in spring and summer should know to take precautions. But many people still don't, experts say, even as the number of nasty tick-borne disease increases.

Last week, the Centers for Disease Control said reported cases of insect-borne illnesses — ticks and mosquitoes, mostly — more than tripled from 27,000 per year in 2004 to nearly 100,000 by 2016.

The CDC says about 35,000 cases of Lyme disease alone are reported annually, but as many as 300,000 people in the U.S contract the disease each year, with most going unreported.

May through July are the most likely months to get bitten by a tick in the region. Right now, spring turkey hunters, kids outside playing on warm days, shed antler hunters, morel mushroom seekers, bird watchers, hikers and even ATV riders are susceptible as the last snow melts away and ticks get active.

"But it can happen as late as deer season, in November, and in a warm winter it can start up in February,'' said Dr. Kevin Stephan, infectious disease specialist with Essentia Health in Duluth.

Stephan strongly encourages anyone who spends time outdoors this time of year to take precautions with a clothing repellent like permethrin and a skin replant like DEET, even if you may not like the feel or smell of chemicals on your skin. He notes studies show the repellents are safe, in commercially available doses, and proven effective in test after test.

"It's weighing risk against benefit,'' Stephan said. "If you can prevent serious or even potentially lethal infection, why not do it?"

New ticks, new diseases

The worst offender is the blacklegged tick, formerly called the deer tick, which spreads Lyme disease, by far the most common and still most serious tick-borne illness in the region and nationwide. The blacklegged tick also can carry babesiosis, anaplasmosis and the emergent Powassan virus.

Blacklegged ticks like a few warm days before they get really active in spring. But they also like humidity, and can be found in damp grass and leaves.

Horton's nemesis in Kansas was the lesser-known lone star tick, which in recent years has moved north into Minnesota. Named for the single white dot on the back of the female tick — the ones that bite — the lone star tick carries several pathogens, including tularemia, southern tick-associated rash illness and ehrlichiosis. New research, published in the journal Emerging Infectious Diseases from the Centers for Disease Control, suggests that disease caused by the lone star tick is increasing and seriously underdiagnosed.

The lone star tick also carries the bizarre alpha-gal bacteria that can spur a severe allergic reaction to meat. It first surfaced in the southeastern U.S. and was only as far north as Iowa just a few year ago. But in recent years, cases have been popping up in Minnesota, even as far north as Duluth.

Victims of Lyme and other tick-borne illness report myriad symptoms, from the common bullseye rash, fever, aches and pain, to fatigue and flu-like symptoms, to full-body rashes, mood changes, vision problems, cognitive issues and even sleep disorder and heart problems.

Stephan says he sees more tick bites and more tick disease every year. When Stephan first started seeing Lyme and other tick cases, they were almost all from south of Duluth. Now, he said, St. Louis County has among the highest Lyme disease rates per capita of any in the state.

"Whether you call it global warming or climate change or whatever, we are seeing more ticks moving further north. We have Lyme all the way to the Canadian border now and we just didn't see that when I first got here'' in 2003, Stephan said. "It's not going away ... It's getting worse.''

Stephan said he's not sure if he's seeing so many more tick-related cases because more people are being bitten and infected or because more people are aware of the possibility and are seeking help if they suspect a problem.

"Probably a little of both," he said.

More ticks carrying disease

Stephan said that a concerning development is the increasing percentage of ticks now carrying disease. When he first started tacking tracking Lyme disease, only about 2 percent of female blacklegged ticks carried the disease. So even if you got bit, chances are you wouldn't be infected.

Now, more than 30 percent of female ticks are infected on average, and in same areas its 40 or even 50 percent.

"The odds used to be in your favor. Now, it's one-in-three or even one-in-two. Those aren't good odds,'' Stephan said.

That's one reason he's suggesting that people who spend a lot of time outdoors in tick country get an advance prescription for a one-time, 200 mg dose of doxycycline, the go-to antibiotic for tickborne diseases. If any small tick become embedded in your skin, first, properly pull the tick out. Then take the antibiotic.

The precautionary dose "is something like 90 to 95 percent effective. In medicine, that's pretty good prevention,'' Stephan said, urging people to get that prescription in advance of being bitten. "You can wait for it to happen. But if it's a Friday night it might be Monday before you get to your doctor'' and time is of the essence.

"If your doctor doesn't know about this, they should,'' Stephan said, noting the dose is small enough to allay concerns about antibiotic resistance.

Stephan also suggests seeing your doctor as soon as possible after tick bites. Because he's a specialist, Stephan often gets the most difficult cases, sometimes patients who went months without seeking medical attention, or months being misdiagnosed by other doctors.

"Take precautions.... And if you still get symptoms, don't delay,'' he said. "The earlier the treatment, the better the outcome."

Protect yourself

• Experts strongly suggest using both a personal insect repellent on your skin as well as a repellent that can be applied to clothing.

• DEET is by far the most effective insect repellent including for keeping ticks away. Multiple studies have found that, in concentrations of 30 percent and under, it's considered safe to use. Other options include picadarin, a synthetic compound first made in the 1980s to resemble the natural compound piperine, found in the plants that produce black pepper.

• Permethrin: Spray on clothing or soak clothing in permethrin to keep ticks and other insects at bay for long periods, often several washes. Considered extreme effective and also works to keep away mosquitos that may be carrying viruses like West Nile and zika.

• Clothing: Ticks usually crawl onto people below the knees and then crawl upward. Wear long-sleeved shirts and long pants. Wear light-colored clothes so it is easier to see ticks on you. Tuck pants inside socks to keep them on the outside of your clothing, giving you more time to see and remove them before they get to your skin and start feeding.

• Check: Experts suggest checking yourself in front of a mirror after coming in from outdoors, or better yet, have someone else help check you. Hotspots are around the waist, under the arms, inner legs, behind the knees and around the head, including in and around the ears and in the hair. Adults should help check their young children for ticks. Save any suspected blacklegged ticks for identification.

• Remove: Prompt removal of embedded ticks helps reduce the chance a disease will be transmitted. Ticks need to be attached for six to 24 hours to transmit disease to humans. The best method for removing a feeding tick is to grasp it as close as possible to the skin of the host with tweezers or tissue paper. Do not squeeze the tick if possible. Gently, yet firmly, apply steady pressure on the tick until you pull it out. If you try to jerk or twist the tick out, you risk the mouthparts breaking off and remaining in the skin. Clean out the wound with a good germicidal agent, such as iodine, to help prevent infection. (Experts say using tape, alcohol or Vaseline to cover the tick and cause it to voluntarily pull its mouthparts out of the skin is ineffective.)

• Save: If there is any question as to whether this tick is a species that can potentially transmit disease, especially blacklegged, save it by placing it in a small container to be identified later.

• Symptoms: For a month or so after a known tick bite, watch for symptoms, including a red spot or rash near the bite site, full body rash, neck stiffness, headache, nausea, weakness, muscle or joint pain or achiness, fever, chills and swollen lymph nodes. Call your doctor if you experience these or if you are bitten by multiple ticks in a short time even without symptoms.

• Dogs also are susceptible to several tick-borne illnesses, including ehrlichiosis, Lyme disease, anaplasmosis and others. Most veterinarians suggest using a topical repellent medication such as Frontline, K9-Advantix or Hertz Ultra Guard, or a tick collar. Many vets also suggest getting dogs vaccinated against Lyme disease.

• 61 percent experienced symptoms in June or July, which corresponds with the most active period for blacklegged ticks (May through August).

• More than half the cases either lived in or recently spent time outdoors in the most tick-prone areas of east-central Minnesota, southeastern Minnesota or western counties in Wisconsin.

A smorgasbord of tick-borne diseases

The Minnesota Department of Health says there are a dozen different types of ticks in the state, although not all spread disease. The most common ticks that people come across in Minnesota are the American dog tick — commonly known as the wood tick — and the blacklegged tick — commonly known as the deer tick.

Diseases ticks can spread:

• Lyme disease, caused by Borrelia burgdorferi, is a potentially serious bacterial infection affecting both humans and animals. It is the most common tick-borne disease reported in Minnesota and in the U.S. and is carried by blacklegged ticks.

• Anaplasmosis, formerly known as human granulocytic ehrlichiosis, is a bacterial disease first recognized in Minnesota in the early 1990s. It's also transmitted by blacklegged ticks.

• Babesiosis is a protozoan infection that occurs infrequently in Minnesota. Up to 20 percent of patients diagnosed with babesiosis also have Lyme disease.

• Ehrlichiosis, caused by ehrlichia chaffeensis, is found throughout much of southeastern and south-central U.S., although a small number of cases have been reported in Minnesota.

• Powassan virus is a tick-borne flavivirus first reported in a Minnesota resident in 2008, with low numbers of cases reported in the state since then.

• Borrelia miyamotoi was identified in 2011 to cause an illness in humans similar to tick-borne relapsing fever. It is distantly related to the bacteria that cause Lyme disease.

• Borrelia mayonii was recently identified in 2013 by the Mayo Clinic — thus the name — to cause an illness similar to Lyme disease. This organism has only been found in eastern Minnesota and western Wisconsin.

• Rocky Mountain spotted fever is extremely rare in Minnesota, but isolated cases have been reported within the state. This disease is transmitted by the American dog tick, also called the wood tick.

• Tularemia is a potentially serious illness that occurs naturally in the U.S. It can be transmitted by American dog ticks as well as biting flies or infected animals. Human cases of tularemia are rarely reported in Minnesota.

• Alpha-gal, a rare disease that spurs an allergic reaction to meat, spread by the lone star tick. A few cases have been reported in Minnesota, including near Duluth.